Organization
INDIAN TERRITORY LONG TERM CARE, INC.
Active
Other names
Indian Territory Provider Care Plus
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. RHONDA JEAN HENDRIX MSNARNPC (C.E.O.)
(580) 371-2106
Entity
Organization
Contact information
Practice address
105 N NESHOBA ST, TISHOMINGO, OK 73460-1739
(580) 371-0015
(580) 371-3204
Mailing address
105 N NESHOBA ST, TISHOMINGO, OK 73460-1739
(580) 371-0015
(580) 371-3204
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
100627980D
OK
251J00000X
Nursing Care Agency
100627980D
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100627980C
—
OK
05
—
100627980D
—
OK
Enumeration date
03/07/2007
Last updated
11/20/2008
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